Having someone around you going through a psychotic episode can be a scary and occasionally dangerous experience, for you as well as for the psychotic individual. A person going through a psychotic episode may hear voices or see people that exist only in their mind, and may act confused or inarticulate. When someone you know is going through a psychotic episode, it’s important to stay calm and assess the situation. Call emergency services if the person is a threat to themselves or others. Otherwise, talk calmly with the person and ask them to take the necessary medications.

Steps

Method1

Assessing a Psychotic Episode

1

Recognize the beginning of a psychotic episode. Psychosis is a symptom of various serious mental illnesses, and is defined as a psychological break with reality. If the person seems to drift mentally, if their speech becomes slurred and incoherent, or if they respond to auditory or visual hallucinations, they might be experiencing a psychotic episode.[1]

If you know a person around you has a history of psychotic episodes, seek hints. Common behaviors in the days before a psychotic episode include: depression or irritability, alternating between inactivity and hyperactivity, and preoccupation with certain ideas, or social withdrawal.[2]

2

Call the person’s name. Talk to the individual, and try to get them to respond and communicate as much as possible. If the psychosis is not too severe, gently ask the individual what they’re seeing or experiencing. Keep them calm and make the conversation as normal as possible.[3]

If you respond to the psychotic episode with fear and anxiety, it could further trigger the psychotic individual and worsen their experience.

Ask if there’s something wrong, and if they respond, try to get them to describe what they’re experiencing.

Say something like, “I’m not sure what you’re experiencing, can you try to describe it to me?”

3

Ask the person if they have any medications for emergencies. If the individual answers coherently and affirmatively, get them to take the medication. Also contact the individual’s mental healthcare provider as soon as possible.[4]

Ask the individual going through this psychotic episode if they’ve had episodes like this before. Find out what helped previously, and repeat that treatment as much as possible.[5]

4

Keep everyone in a safe place. If the individual is anxious indoors, it may be worth taking the person outside, or sitting somewhere relatively secluded (that isn’t public, but where you can still get help if needed). Keep children away from the person during the episode, and take especial care to keep away other vulnerable people (old, disabled, etc.) if you believe the person may become violent.

Children may be scared, curious, or needy, and could upset the person who is having the episode.

5

Err on the side of caution. Psychotic episodes are serious occurrences, and you need to treat them as such. If you’re around someone who may be having a psychotic episode (especially if it’s someone you don’t know), or if you’re not sure if they may become violent, you should assume that they may be dangerous.

If you don’t know the person having the episode, call for help. They may have a friend or family member nearby who is better equipped to assist them.

Method2

Handling a Violent Psychotic Episode

1

Assess the situation for danger. It is rare for an individual undergoing a psychotic episode to become violent, although it can happen. Psychotic individuals are at a greater risk of harming themselves.[6] Any threats of violence, self-harm, or suicide should be taken seriously.

A history of drug and alcohol abuse increases the likelihood of the psychotic individual becoming violent.

2

Stay away if the situation becomes threatening or violent. If at any point you suspect the person might be dangerous, either to themselves or to others, call for help immediately. Consider calling an ambulance or other medical experts specifically—if there’s no time to look up phone numbers, just call 911.

If you’re in a room with a dangerous psychotic individual, leave the room immediately.

If police arrive on the scene, try to explain the situation before they interact directly with the person experiencing the psychotic episode. Without interfering and endangering yourself or others, encourage officers to remain calm and resolve the situation without the use of force.[7]

3

Protect the psychotic individual from themselves. If the person is dangerous to him- or herself, remove any sharp objects and dangerous materials from the person, and lock any un-barred windows and balconies. Try to keep the person calm. Call the police or an ambulance if there’s a chance the person will attempt suicide or cause themselves serious physical damage.

Speak to the individual calmly, and try to de-escalate the situation. If the psychotic individual is asking for things or making demands, comply with those that are safe and reasonable.[8]

4

Don’t try to restrain the person or calm them down. If the psychotic individual is acting violent or threatening violence, don’t take it on yourself to solve the problem. You could risk personal harm, especially if you try to engage in a physical struggle with the psychotic individual.

Your main priority should be keeping yourself and others safe. If you can do things to protect the psychotic individual (e.g. removing a knife from a nearby table top), make sure to keep yourself safe while doing so.

Method3

Handling a Non-Violent Psychotic Episode

1

Hold a calm conversation. If the psychotic individual is not violent, sit next to them, and talk to them in a normal voice. Try to comfort them, if they experience or hallucinate something unpleasant. The conversation should be simple; individuals going through a psychotic episode may find communication or speech difficult.[9]

Ask the individual questions, and if their mind seem to be drifting, try to grab their attention.

2

Do not play into the person’s hallucinations. Although you want to avoid blaming or criticizing the psychotic individual, you should also avoid playing into their psychoses. [10] This will only worsen the situation and make the individual’s break with reality more difficult to come back from.

An individual going through a psychotic episode may not realize that what they’re experiencing is unreal or the way they’re acting is abnormal.

Show understanding. Empathize as much as possible; psychosis can be a confusing and frightening thing to experience. The psychotic individual cannot “snap out of it,” nor is it a “punishment” of any sort. It is not their fault and they shouldn’t be blamed for it.[11] Let the person know that you take them seriously and support them. Say things like:[12]

“I can’t imagine what you are going through, but I’m happy to listen.”

“Tell me what you’re experiencing, and I think you should also talk about it with your doctor.”

“This experience will pass with time, let’s talk until you feel better.”

4

Get them to a doctor. A psychiatrist or psychologist can help figure out what caused the episode, and help prevent future psychotic episodes. If the individual is not already undergoing therapy and medical treatment, strongly encourage them to do so after the psychotic episode has passed.[13]

Mental-health professionals will be able to help the psychotic individual take steps to decrease the frequency and severity of their episodes.

Things like self-care, stress management, and counseling can make a large difference to the person’s mental health.[14]

5

Seek help yourself if you need it. Dealing with someone else’s psychotic episode can be mentally traumatic, especially if the individual is a close friend or family member. It may help you to talk to a therapist or counselor.

If you’re close with the individual who had the psychotic episode, follow up with them as well. Make sure they’re safe and healthy. As long as you don’t downplay the importance of their own experience, you can tell them about your experience of their psychotic episode and why it was difficult for you as well.